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MUSICAL BRAIN SURGERY

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Violinist Roger Frisch plays a violin during deep brain stimulation surgery at Mayo Clinic in Rochester. The operation was done in 2010 to control tremors in his right hand so he could continue to play professionally. Photo courtesy of Mayo Clinic
The show must go on … during brain surgery
By
Kay Fate, Staff Writer

Roger Frisch had a long and illustrious career as an elite musician, soloing at Carnegie Hall and playing for audiences worldwide.

“After 45 years with the Minnesota Orchestra, and all my travels, you’d think the violin would be the thing I’m known for,” he said. “But you have to get 11 or 12 pages into an Internet search before you learn about that.”

Well, not exactly.

The first 11 or 12 pages of a search do mention Frisch’s musical ability; specifically, his violin performance during brain surgery.

Though he cringes about the “noise” he made, that moment in the operating room was the first time in four years that he was able to draw a smooth bow.

He shared his story last week during an event hosted by the Owatonna chapter of the American Experiment, sponsored by Mayo Clinic Health System.

 

The signs

Up until 2008, Frisch didn’t know anything about tremors. He was the associate concertmaster of the Minnesota Orchestra, had an active Chamber music schedule, taught violin at a university, and gave private lessons in his home. He and wife, Michelle, also a professional musician, have three children.

“I knew of musicians who had to quit playing, but that wasn’t me,” he said of his attitude then. He was at the top of his game.

A trip to China in 2009 changed all of that.

His right hand, the one he uses to draw the violin bow, shook slightly as he practiced with an orchestra. He’d landed in the country three hours earlier, after 28 hours of traveling.

“Nerves can hit you at any time,” Frisch said, “but I was too tired to be nervous. I figured I’d get a good night’s rest and be fine the next day.”

He wasn’t. Frisch called Michelle, back in Minnesota, and asked her to start looking for doctors.

 

The answer

Multiple specialists tried – and failed – to diagnose the issue.

Many of them, Frisch said, chalked it up to overuse/abuse of his arm after years of playing the violin – much like a tennis player or baseball pitcher can do permanent damage.

He wasn’t willing to accept that diagnosis, “and frankly, I didn’t believe it,” Frisch said.

Another miss: dystonia, a movement disorder that typically causes the muscles to contract involuntarily in repetitive or twisting motions.

Finally, an orthopedist told Frisch he had “absolutely no idea what was wrong with me,” but told the musician about a Mayo Clinic doctor he’d met at a seminar the day before.

The orthopedist referred Frisch to Dr. Joseph Matsumoto, a motion neurologist at the world-renowned clinic in Rochester.

The diagnosis was immediate and certain: essential tremor. The most common trembling disorder, Frisch described it as “the little kid brother to Parkinson’s disease.”

 

The treatment

Essential tremor can be treated with medication, Matsumoto told him. If that didn’t work, there was a surgical intervention – a procedure called deep brain stimulation, or DBS.

It requires drilling a hole in the patient’s head, then threading an electrode into the thalamus, the portion of the brain that causes the tremors. A wire from the electrical probe runs under the skin to a pacemaker-like device that’s implanted in the chest.

That device, a neurostimulator, transmits painless electrical pulses to interrupt signals from the thalamus that cause the tremors.

It all sounded like a lot to Frisch, who chose the medication route.

“Ain’t no way somebody’s going to drill a hole in my head,” he remembers saying.

But while the medication controlled the tremors, “it turned me into a zombie,” Frisch said, and the tremors still got worse.

“Suddenly, somebody drilling a hold in my head didn’t seem like such a bad idea,” he said

Matsumoto had the perfect driller in mind: Dr. Kendall Lee, a neurosurgeon at Mayo Clinic.

 

The consultation

At first, Lee was “completely unimpressed with this wimpy thing I came in with,” Frisch said of the tremor in his right hand.

Lee was accustomed to treating patients with large-scale, sometimes full-body shaking.

“He looked totally bored,” Frisch said, “but I always brought my violin (to appointments) with me, so I could show the doctors how it affected me.”

When Frisch opened the case, Lee’s “eyes lit up, and he said, ‘you’re the perfect patient!’”

While DBS typically involves one probe on each side of the brain, Lee was looking for someone who could benefit from having two probes on the same side, in the same place. It was a surgery that had never been attempted.

Frisch and Lee were both eager to do it immediately, but Michelle convinced her husband to think it over for a bit.

His resolve only grew during that time; he had been asked to play “Ave Maria” for the 2009 Minnesota Orchestra Christmas concert. It would be the last one to feature famed trumpeter Doc Severinsen, who was the orchestra’s pops conductor laureate.

Frisch, who said the piece requires masterful bow control, “hid behind the harp” during the concert.

He was more than ready for the surgery.

 

The operation

Patients are often kept awake during DBS to ensure the surgeon isn’t disrupting normal brain function.

Frisch was no exception, but Lee wanted to take it a step further: He wanted his patient to play the violin during the operation in order to measure the effectiveness of the procedure.

Mayo is well-known for its custom surgeries. The medical engineers had several challenges in Frisch’s case.

They needed to have a larger-than-normal sterile field to accommodate the motion of the bow; they needed to keep Frisch perfectly still, even as he played; and they needed an accelerometer attached to the bow to measure the vibration, or acceleration of motion.

So, Frisch said, “they bolted me to the table” to keep his head motionless.

But he wasn’t about to take his 250-year-old instrument into a room to be handled by strangers who were focused on something else.

“So the Mayo engineers wasted no expense – they went on eBay and bought a violin for $75,” Frisch deadpanned, and planned around it.

The accelerometer, it turned out, was taken from an engineer’s son’s Wii gaming system and attached to the cheap bow that came with the violin.

“I was sworn to secrecy for years,” Frisch said. “I couldn’t tell anyone it just came from a Wii.”

 

The success

When the first electrode found its mark, Frisch was handed the violin and asked to play.

“It was much better,” he said, “but only ‘much better.’ It wasn’t good enough to play professionally.”

When the second lead went in, “I drew the bow, and my hand was perfectly steady. That’s when I knew it was 100% successful.”

The moment in March 2010 was captured by a Mayo Clinic film crew and later used in the 2018 Ken Burns documentary marking the 150th anniversary of the Rochester institution. Frisch is interviewed extensively in the film.

“People see me lying down, scratching away, and they always ask, ‘what did you play?’” Frisch said. “There’s only so much you can play like that, so I tried everything I knew.”

Thirteen years later, Frisch is now retired from the Minnesota Symphony. He still spends most of his time traveling, though, sharing his experience and the importance of DBS.

His essential tremor remains, something he displays by switching the neurostimulator on and off with an app. The impulses have been strengthened as his tremors worsen. They are starting to affect his left hand.

Lee, Frisch said, “wants to go back in” to address the issues, “but I’m not there anymore.”

Perfection is no longer the goal, but he still draws a smooth bow as he performs during his speaking engagements.

“I realized early on in my career that the violin is the unofficial reason I get to travel all over this world,” Frisch said.

“It still is.”

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